소아 아토피피부염에서 비타민 D의 역할

염혜영 ( Hye Yung Yum ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, with a prevalence of up to 15%-20% in children and 2%-10% in adults. Patients with AD have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Recently, there has been increasing awareness of the importance of vitamin D, a potential factor, in the development and progression of atopic diseases including AD. Furthermore, some reports suggested that vi￢tamin D deficiency impairs epithelial integrity, leading to increased and inappropriate mucosal exposure to antigens promoting sensitization. Even though numerous studies favor strong associations of vitamin D deficiency during pregnancy and infancy with allergies, high vitamin D intake might be harmful according to conflicting results of other trials. The growing body of the literature indicates an inverse relationship between the severity of AD and vitamin D levels. Animal studies, case reports, randomized clinical trials, and birth cohort studies have suggested that vitamin D may alleviate the symptoms of AD through immune-modulation of the innate and adaptive immune system. Moreover, some studies have shown that in individuals with AD with low vitamin D level, repletion of vitamin D results in decreased severity of diseases. However, all these results have prompted the question of which time, dose, duration, or mode of application of vitamin D might be appropriate in children with AD. Further large cohort studies and clinical trials are warranted to assess the role of vitamin D in the prevention and treatment of AD in children.(Allergy Asthma Respir Dis 2015;3:95-98)

알레르기 질환과 모유수유

염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.4

쌀과 저항원성 쌀 및 유전자 재조합 쌀의 알레르기 항원성의 비교

염혜영 ( Hye Yung Yum ),이경은 ( Kyung Eun Lee ),최성연 ( Sung Youn Choi ),양혜선 ( Hea Sun Yang ),손명현 ( Myung Hyun Sohn ),이상일 ( Sang Il Lee ),박혜경 ( Hye Kyung Park ),박선희 ( Sun Hee Park ),이순호 ( Soon Ho Lee ),이우영 ( 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2005 소아알레르기 및 호흡기학회지 Vol.15 No.2

아토피피부염 교육 프로그램을 통한 질병인지도 변화

염혜영 ( Hye Yung Yum ),한기옥 ( Ki Ok Han ),박지애 ( Ji Ae Park ),강미연 ( Mi Youn Kang ),장석일 ( Suk Il Chang ),조상헌 ( Sang Heon Cho ),편복양 ( Bok Yang Pyun ),나영호 ( Yeong Ho Rha ),김규한 ( Kyu Han Kim ),윤호주 ( Ho Joo Yo 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.1

Background: Education programs are essential in improving disease management and quality of life in patients with atopic dermatitis and their families by promoting disease knowledge. In these perspectives, the Seoul Atopy Asthma Education and Information Center has been established under the project ``Atopy-free Seoul`` by Seoul City since 2008. Our goal is an improvement in public health through development of education programs and counseling activities based on scientifically proven medicine. However, implementation and evaluation of effectiveness of education programs are needed to redeem configuration. The aim of this study was to determine the necessity of an education program of atopic dermatitis for optimal disease management. Methods: An education program for citizens was designed by the advisory organization of Korean Asthma Allergy Foundation. To evaluate the efficacy of the education program, 9 questionnaires about disease knowledge were developed. Participants were asked to answer the questionnaires and differences in the percentage of correct answers were compared before and after the program education. Results: In 5 sessions, 359 participants responded to the survey on disease knowledge before and after the education program. There was significant increase in the percentage of correct answers to 5 out of the 9 questions. This result proved that the education program was effective in improving the disease knowledge of atopic dermatitis. Conclusion: Significant improvement in disease knowledge after education of atopic dermatitis supports the need and feasibility of education programs for citizens. (Korean J Asthma Allergy Clin Immunol 2012;32:21-25)

천식의 만성기도개형에서 섬유아세포성장인자와 그 수용체의 역할

염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회 2006 소아알레르기 및 호흡기학회지 Vol.16 No.4

A number of structural changes occur in the airway wall in asthma. The most characteristic is thickening of the subepithelial lamina reticularis which is observed in bronchial tissue even in patients with mild disease. This pathophysiological change which was the result of deposition of interstitial collagens by increased numbers of myofibroblasts is likely to be directed by growth factors having fibropoliferative and profibrotic effect. The acivation of the epithelial-mesenchymal unit involves reciprocal activities of growth factors belonging to the fibroblast growth (FGF), epidermal growth factor (EGF), and transforming growth factor-β families. Among them FGF is a member of family of heparin binding growth factors that affect the growth and differentiation of a large number of cell types. Especially basic FGF involved in morphogenesis, wound repair, inflammation, angiogenesis, and tumor growth and invasion, and require the glycosaminoglycan side chains of heparan sulphate, proteoglycans for high affinity binding to their specific receptors. Few studies suggested bFGF would be an important regulator of airway remodeling by means of paracrine control of bronchial myofibroblasts in response to cell damage and repair. [Pediatr Allergy Respir Dis(Korea) 2006;16:267-273]

난치성 소아간질에서 Lamotrigine의 치료효과

염혜영(Hye Yung Yum),김영래(Young Rae Kim),차병호(Byung Ho Cha),이준수(Joon Soo Lee),고창준(Chang Jun Coe) 대한소아신경학회 1995 대한소아신경학회지 Vol.3 No.1

연구 배경 : 기존의 항경련제로 치료되지 않았던 난치성 간질 소아 간질에 있어서 lamotrigine의 치료 효과를 알아보고자 본 연구를 시행하였다. 방법 : 연세 의대 세브란스 병원 소아과에서 난치성 간질로 진단받은 환아 90명(남 59명, 여31명)에게 그동안 복용하던 항경련제는 그대로 복용하면서 lamotrigine을 추가로 복용하게 하고, 1개월 간격으로 발작의 빈도 및 부작용의 발현 여부를 추적 관찰하였다. 용량은 sodium valproate를 투약받고 있지않은 환아는 2주동안 1일 1회 1mg/kg를 투여 후 2-4주동안 2mg/kg를 하루 2회 투여한 후 점차 증량하였다. Sodium valproate를 투약받고 있는 환아는 2주동안 1일 1회 0.5mg/kg를 투여 후, 점차 증량하였다. 결과 : 전체 대상 환아 중 lamotrigine 추가 투여 후 발작 감소를 보인 환아는 65명(72.2%)이었고 그중 23명(25.6%)에서는 전혀 발작이 없었으며, 25명(27.8%)에서는 50%이상의 발작 감소를,17명(18.9%)에서는 50%미만의 발작 감소를 보였다. 발작의 유형에 따른 치료 결과는 50%이상의 발작 감소를 기준으로 할때 복잡 부분성 발작이 75%(3/4), 전신성 발작이 54.1%(33/61), Lennox-Gastaut 증후군이 54.5%(12/22), 미분류성 발작이 0%(0/3)로 나타났다. 투약 기간중 부작용이 관찰된 환아는 모두 4명(4.4%)이었다. 결론 : 소아 난치성 간질에 lamotrigine을 추가로 투여하여 좋은 효과를 관찰하였으며, 부작용은 매우 적었다. Background : This study was performed to observe the efficacy of lamotrigine in children with intractable epilepsy. Method : 90 patients who have been treated with known antiepileptic drugs Yonsei University College of Medicine Severance Hospital were reviewed. Lamotrigine was added on other antiepileptic drugs. The frequency of seizure attacks, and occurrence of adverse effects were monitored monthly at outpatient unit. Results : Approximately 70% of patients experienced reduction in seizure frequencies after medication of lamotrigine. The percentage of children who experivenced 50% or greater reduction in seizure frequency according to seizure types were 75% in complex partial seizure, 54.1% in generalized seizure, and 54.5% in Lennox-Castaut syndrome. Among them. 4 children had adverse effect. and stopped the medication. Conclusion : Lamotrigine add-on therapy seems to be effective in children with intractable epilepsy and adverse effects were trivial.

운동유발성 천식의 자연경과에 관한 연구

염혜영(Hye Yung Yum),김규언(Kyu Earn Kim),강혜영(Hay Young Kang),정병주(Byung Ju Jeoung),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1996 소아알레르기 및 호흡기학회지 Vol.6 No.1

N/A To counsel parents about the future prospects of EIA in their children, it is very important to know the prognosis of EIA, As there is no report concerning the natural history of EJA, we performed this study. Forty-seven children (male 37, female 10) were included in this longitudinal evaluation, all of whom were diagnosed as having EIA through the exercise loading test at least two years ago (mean 35/12 years). We performed a follow-up exercise loading test and compared the results. The children were tested with the up and down stairs method for 6 minutes. The changes in pulmonary function were measured by a peak flow meter. The results are as follows: 1. Twenty-eight cases of 47 children(59.6%) didn't reveal EIA when we performed the follow-up exercise loading test. There was no difference between boys and girls. 2. When we analyzed the data according to the severity of EIA, we had the following results: 70.8% of mild EIA, 53.8% of moderate EIA, and 40.0% of severe EIA were shown to not have EIA. 3. The remission of EIA was not correlated with total eosinophil count, total IgE level and the number of positive allergen in skin test at initial diagnosis. In conclusion, the 59.6% of children with EIA demonstrated to have remission of their EIA after 2 or more years. The remission rate was the highest (70.8%) in mild EIA.

유전자 재조합 콩과 순수 콩의 단백화학적 특성의 비교

염혜영 ( Hye Yung Yum ),이경은 ( Kyung Eun Lee ),손명현 ( Myung Hyun Shon ),김철홍 ( Chul Hong Kim ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2002 소아알레르기 및 호흡기학회지 Vol.12 No.1

아토피피부염의 보완의학

이수형 ( Soo Hyoung Lee ),염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2008 소아알레르기 및 호흡기학회지 Vol.18 No.4

목적: 아토피피부염은 만성 알레르기 염증성질환으로서 소아에서의 유병률이 10-20% 정도로 흔한 피부질환이다. 설문연구에 의하면 많은 수의환자들은 과학적으로 검증되지 못한 `보완의학`을 이용했거나 이용하고 있는 게 현실이다. 보완의학에 대한 연구는 어느 정도 되어 있는지 살펴보고자 하였다. 방법: 논문 검색은 Entrez Pubmed를 통해 `최근 5년이내`, 검색주제어는 `atopic dermatitis complementary/alternative medicine`으로 검색하여 중복되지 않은 범위에서 약물이나 약초를 통한 치료를 주로 한 논문들을 선택하여 고찰하였다. 결과: 한약제제는 4건의 무작위임상시험이 시행되었는데 증상 감소, 만족도에서 효과가 있을 수 있다고 하였지만 일치되게 나오지는 않았다. 좋은 연구설계의 좀 더 큰 규모의 임상시험을 통한 검증이 필요하다. 동종요법에 대해서는 외국에서는 비교적 많은 연구가 되었는데 일관되게 뚜렷한 효과를 나타내지는 못했다. 특히 아토피피부염 환자만을 대상으로 한 연구는 많이 부족한 실정이다. 그 외 여러 식물 추출물에 관해서는 성분분석 등의 실험연구는 많은 부분 진행되었지만 임상시험은 디자인이나 규모 면에서 아직 부족한 실정이다. 결론: 보완의학은 과학적 검증에 비해 너무나도 많은 사람이 이용하고 있고 그 경제적 비용 또한 무시할 수 없는 현실이기에 우리나라에서도 실험연구에서부터 임상시험까지의 체계적인 접근이 필요하겠다. Purpose: The prevalence rate of atopic dermatitis which is a common disease as is 10-20%. By the questionnaire survey, many patients used or have been used complementary medicine which has not been verificated. We review to look around the studies in complementary medicine of atopic dermatitis. Methods: We searched the journals through Entrez Pubmed within the limits: recent 5 years and atopic dermatitis complementary/alternative medicine. And then, we selected and reviewed the journals which introduced treatment for atopic dermatitis by drugs or herbs within terms which was not overlapped. Results: There were 4 randomized clinical trials about Chinese herbs that had possible effects on relieving symptoms and self-satisfaction, but they were inconsistent. Examinations would be required through well-designed and clinical trials with a large sample size. There were relatively a lot of studies of homeopathy in the foreign countries, but had no consistent and definite effects. Especially, there were few studies of homeopathy in atopic dermatitis patients. In addition, experimental studies in extracts from plants such as flavonoids have proceeded mostly (ex. chemical experiment), but there were few clinical trials which were well-designed or sufficient sample size. Conclusion: Complementary medicine has been used by many people for scientific verification, and economic costs for it were so considerable that systematic approaches from experimental trials to clinical trials would be needed. [Pediatr Allergy Respir Dis(Korea) 2008;18:326-338]

서울시 초등학생 아토피캠프 사업의 효과

손동국 ( Dong Koog Son ),홍소영 ( So Young Hong ),김현정 ( Hyun Jung Kim ),염혜영 ( Hye Yung Yum ),이수형 ( Soo Hyung Lee ),조미래 ( Mi Rae Cho ),고은실 ( Eun Sil Ko ),조성은,임완령 ( Wan Ryung Lim ),권호장 ( Ho Jang Kwon ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.2

목적: 서울시가 주관하고 서울의료원에서 주최한 2010년 아토피캠프는 아토피피부염 환아와 가족에게 아토피피 부염 관리 방법의 교육으로 생활 습관의 개선을 유도하고자 하였으며, 본 연구에서는 아토피캠프에 참여한 아토피피부염 환아들의 캠프 만족도 지식의 변화 및 생활 습관의 변화를 알아보고자 하였다. 방법: ``서울시 아토피안심학교``의 초등학교 아토피피부염 아동과 보호자를 대상으로 2010년 5월 22일부터 10월24일 까지 매월 2째, 4째주 토요일과 일요일 총 10회에 걸쳐 아토피캠프를 실시하였다. 설문조사는 캠프 전후에 실시 하였으며, 캠프 참가 환아 374명 중 미기재 응답 문항이 많은 11명을 제외한 363명의 설문지를 분석대상으로 하였다. 또한 캠프 3개월 후 효과 평가를 위해 실시한 우편 설문 조사에는 캠프참여자 374명 중 167명이 응답하였으며, 응답률은 44.7%였다. 결과: 아토피캠프의 체험프로그램이 교육프로그램보다 만족도가 높았고, 저학년이 고학년에 비해 교육프로그램 만족도가 높았다. (P<0.001) 아토피피부염에 대한 지식은 캠프 전에는 학년이 높을수록(P<0.001) 그리고 아토피피부염 증상이 있는 경우에 높았고(P0.01), 캠프 후에는 학년이 높을수록 지식이 높았다. (P<0.001) 아토피캠프 3개월후 ``1주일 동안의 목욕 및 샤워의 횟수``, ``면 수건으로 톡톡톡 두드려 닦음``, ``샤워나 목후 후 3분 이전에 보습제 바르기`` 그리고 ``1일 보습제 바르는 횟수가 통계적으로 유의하게 증가하였다. (P<0.001) 피부가 가려울 때 ``가려우면 언제라도 그냥 긁음 은 감소하였고, ``몇 번 긁는지 긁는 횟수를 세어봄``이나 ``안 긁으려고 다름 생각을 함``은 증가하였으며(P<0.001), 아토피피부염 때문에 친구들이 놀릴 때 ``하지마 라고 말함``의 비율이 증가하는 등 캠프 후 생활 습관이 긍정적으로 변화하였다. Purpose: In this study, we attempted to analyze the effectiveness of the atopic dermatitis camp for primary school students in the Seoul area. Methods: Seoul city`s atopy camp 2010 was conducted 10 times from May 22nd to October 24th for primary school students at an atopy friendly school and their parents. A total of 374 atopic dermatitis patients participated in the camp and questionnaires for 363 were analyzed, except 11 participants who had left several questions unanswered. In a 3-month follow-up survey, 167 participants out of 374 responded to the mailing questionnaire to evaluate the efficiency of the camp. The response rate was 44.7%. Results: Satisfaction with the educational program of the camp was higher for lower grade students than for higher grade students.(P<0.001) Before camp, higher grade students (P<0.001) or students with severe symptoms were more knowledgeable of atopic dermatitis.(P<0.01) After the camp, the higher the grade, the more the knowledge the student had about atopic dermatitis.(P<0.001) Three months after the camp, there was positive change in the lifestyle of atopic dermatitis patients.(P<0.001) Conclusion: Knowledge on atopic dermatitis increased and the lifestyle of atopic dermatitis patients was improved due to the camp. Consequently, Seoul city`s atopy camp can be utilized as a method to improve the quality of life of atopic dermatitis patients and their family. And Seoul city`s atopy camp is expected to be a model for atopy camps in other local communities.